The math of invasive breast cancer risk for LCIS
Lobular Cacrinoma in Situ (LCIS) confers a risk of invasive breast cancer of about 2% a year, maybe a little less, when chemoprovention endocrine meds are NOT taken. If meds are taken, the risk is cut in about half, maybe even cut a little more, so 1% or less.
Furthermore, LCIS is a lifetime risk. That means any 40 year old woman diagnosed with LCIS who could expect to live until 85 has a lifetime risk of 2%/year x 45 more years of life = 90% lifetime risk of cancer. Let's say the risk is only 1.5% per year, to be wildly optimistic and not 2%, since some studies have indicated the annual risk is less than 2%. Then that comes out to a 67.5% lifetime risk, still a big number. (1.5%/year x 45 more years of life)
Other sources show a lifetime risk of developing invasive breast cancer with LCIS to be 20% with some showing up to 35%. Those results do not come out to 2%/year for most women, unless the diagnosis is made at around 65 years or older.
Examples: Age 65 at diagnosis with life expectancy of 85 years means if using even the lower 1.5%/year risk, it is 1.5%/year x 20 more years of life = 30% lifetime risk. Age 70 at diagnosis with life expectancy of 85 years, again using the 1.5% figure is 1.5%/year x 15 more years = 22.5% lifetime risk.
Even the halved annual risk of 1% over a lifetime that may be obtained by taking chemoprovention endocrine meds still does not add up to a halved 10%-18% (instead of 20%- 35%) life time risk of invasive breast cancer,
Example: LCIS diagnosis at age 40 with life expectancy of 85. 1%/year x 45 years to reach age 85 = 45% lifetime risk. While better than even odds for a 40-year old, I think many women would consider something that close to 50% of getting cancer to be too high, especially after investing 5-10+ years of taking risk-reducing drugs, which produce substantial side effects for many. But a diagnosis at age 55 with a 1% annual risk due to medications, would result in a 30% lifetime risk, if life expectancy was 85. (1%/year x 30 years = 30%)
Interestingly, I have repeatedly seen that of all the LCIS diagnoses, only 10%-20% are in women past menopause, so using ages 55-75 for examples to make the annual risk come out similar as lifetime risk does not reflect the reality of who has the most cases of LCIS. I have also read that the number of post-menopause LCIS cases, though now a minority, is growing. And I am one.
Some of us have high hopes of making it to 90+ if we've had many relatives who have lived that long, so that means that 2%/year (or the more optimistic 1.5% or even the 1% with drugs) really makes lifetime risk soar upward.
For women diagnosed in their 30s, or younger, those 2%s accumulate over an even longer period, so that the odds of invasive cancer could easily reach 100% over a lifetime. Or more, but of course that is not possible. However, no studies I have found warn of guaranteed invasive breast cancer (100%) for those with LCIS if you live long enough.
Something does not add up. Perhaps it is the mathematician, (me). Or my LCIS assumptions are wrong. Maybe risk does not increase in a linear fashion year after year, maybe it tapers off? It seems to me that either all the lifetime risk numbers out there from reputable sources are wrong or the 2%/year over a lifetime (halved or more with medication) is wrong. So that those of us with LCIS can decide what treatment is best, we need to know which numbers are right–and which are wrong.
Can the Mayo experts or the moderator or another poster shed some light? Thank you in advance.